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263
ENDO (Lond Engl) 2010;4(4)263266
ORIGINAL ARTICLE
Rodrigo Sanches
Cunha, DDS, MSc,
PhD
School of Dentistry, Catholic
University of Campinas,
Campinas, SP, Brazil
Vanessa de Oliveira
Alves, DDS
So Leopoldo Mandic
Dental Research Center,
Campinas, SP, Brazil
Renata Gargione
Prado, DDS
So Leopoldo Mandic
Dental Research Center,
Campinas, SP, Brazil
Srgio Luiz Pinheiro,
DDS, MSc, PhD
School of Dentistry, Catholic
University of Campinas,
Campinas, SP, Brazil
Carlos Eduardo da
Silveira Bueno, DDS,
MSc, PhD
So Leopoldo Mandic
Dental Research Center,
Campinas, SP, Brazil
Correspondence to:
Rodrigo Sanches Cunha
Rua Clvis Bevilacqua, 243,
sala 10, Guanabara
Campinas, SP, Brazil
CEP: 13073-021
Tel: (55 19) 3212-0579 /
(55 19) 8144-3377
Email: rscunha@dglnet.
com.br / rodrigo.odonto@
hotmail.com
Rodrigo Sanches Cunha, Vanessa de Oliveira Alves, Renata Gargione Prado, Srgio Luiz Pinheiro,
Carlos Eduardo da Silveira Bueno
Inuence of gutta-percha solvents used in
endodontic retreatment on the effectiveness
of the Root ZXII apex locator
Key words electronic apex locator, tooth length determination, working length
Introduction
Correct working length determination is an impor-
tant factor leading to success in root canal treatments.
Studies have shown the histological results after endo-
dontic treatment to be superior when instrumentation
and root lling are limited to the apical constriction.
Therefore, accurate determination of the location of
the apical constriction is a key factor in successful
root canal therapy. This limit is usually located ap-
proximately 0.5 to 1.0mm from the anatomic apex
1
.
During conventional tooth length determina-
tion, the radiographic apex is considered a refer-
ence for establishing canal length. In most cases,
The aim of the present in vitro study was to determine the inuence of different gutta-percha
solvents used in endodontic retreatment cases on the accuracy of the Root ZX II electronic apex
locator in locating the apical foramen. Thirty human, single-rooted permanent teeth were divided
into three groups according to the solvent used: group OPO (orange peel oil, n = 10), group XYL
(xylol, n = 10) and group CHL (chloroform, n = 10). Tooth length was established visually under
5 magnication with the aid of an optic microscope and then compared with the correspond-
ing electronic measurement with a safety margin of 0.5 mm. The results were analysed by the
Biostat 4 program. The electronic and visual measurements coincided in 90% of the cases for xylol, in
100% of the cases for chloroform and in 100% of the cases for orange peel oil. No signicant differ-
ence was observed among the three gutta-percha solvents in accurately locating the apical foramen
(P = 0.607). Based on the results, it was possible to conclude that the accuracy of Root ZX II was not
adversely affected by the presence of the gutta-percha solvents used in endodontic retreatment cases.
however, the apical foramen does not coincide with
the radiographic apex, leading to the establishment
of an incorrect working length when compared to
the actual position of the apical foramen
2,3
.
Since the rst apex locator was introduced by
Custer
4
in 1918 and improved by Sunada
5
in 1962,
a number of different devices have been introduced
and used in dentistry, based on an electric resist-
ance method (rst generation), single frequency
impedance (second generation) and impedance
under multiple frequencies (third generation)
2
. The
greatest advantage of the latter method is greater
precision (80% to 95% of the cases), even in the
presence of blood, pus or pulp tissue
6,7
.
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Cunha et al Influence of gutta-percha solvents on the Root ZXII apex locator 264
ENDO (Lond Engl) 2010;4(4):263266
Effective root canal length determination during
the retreatment procedure makes it easier for the
operator to completely remove the lling material
used initially, thus facilitating a precise preparation
and an adequate re-lling of the canal
8
.
Several studies have demonstrated the effective-
ness of apex locators in determining the working
length
9,10
. Some of them have stated their effective-
ness in retreatment cases
8,11
, but have not investi-
gated the possible correlation between the locators
function and the concomitant use of gutta-percha
solvents. Thus, considering the lack of studies evaluat-
ing the use of apex locators in conjunction with these
substances in the related literature, the aim of the
present in vitro study was to determine the inuence
of different gutta-percha solvents used in endodontic
retreatment cases (xylol, chloroform and orange peel
oil) on the accuracy of the Root ZX II electronic apex
locator in locating the apical foramen.
Materials and methods
Thirty human, single-rooted, extracted teeth with
complete root formation and displaying a single root
canal were used in the present study. These charac-
teristics were conrmed through radiographs in the
bucco lingual and mesiodistal directions. The teeth
were stored in a 0.9% sterile saline solution until
used. The crown was sectioned with a diamond disk
(Carbodent; Gysi, Buenos Aires, Argentina) to facilitate
access to the canal and establish a at surface to serve
as a steady reference for all of the measurements.
Number 2 Gates Glidden burs (Dentsply Maillefer, Bal-
laigues, Switzerland) were used to prepare the coronal
third of each canal. The canals were irrigated with
saline solution during access and preparation, and pat-
ency of the apical foramen was determined with a size
10 K-File (Maillefer, Ballaigues, Switzerland).
Root length was established by inserting a size 15
K-File (Maillefer) in the canal until its tip was visible
at the apical foramen. This procedure was conducted
under 5 magnication using an operative micro-
scope (DF Vasconcelos, So Paulo, SP, Brazil). After
adjusting a silicone stop at the cervical cut limit, the
le was removed from the canal and the distance
between the le tip and the stop was measured with
the aid of an endodontic ruler (Maillefer), allowing
accurate measurements to within 1 mm. Whenever
the tip of the le was located between the 1 mm
notches of the ruler, an intermediate 0.5 mm was
added to the nal length recorded for the measure-
ment. This measurement was recorded as the real
canal length and the data were tabulated.
For the electronic measurements, the roots were
immersed in plastic containers containing alginate
(Jeltrate

, Dentsply, Petropolis, RJ, Brazil) in order

to simulate the conductivity conditions of the perio-
dontium. The handling of this material was per-
formed following the manufacturers instructions,
but saline solution was used instead of water
8,12,13
.
Two orices were created in the alginate: one at the
middle of the plastic container where the root was
placed, and another laterally to the root where the
labial clip of the locator was positioned.
The roots were divided into three groups with 10
roots each (n = 10). Using a syringe (Injex, Ourinhos,
SP, Brazil), each canal was lled with 0.2ml of each
gutta-percha solvent tested, according to the groups
below:
OPO: orange peel oil (F & A Laboratory Pharma-
ceutical, So Paulo, SP, Brazil)
XYL: xylol, C
6
H
4
(CH
3
)
2
(F & A Laboratory Phar-
maceutical)
CHL: chloroform, CHCl
3
(F & A Laboratory Phar-
maceutical)
The alginate was kept moist during the taking of all
measurements. The labial clip was immersed in the re-
spective orice and the le that best tted the anatom-
ical diameter of each tooth was connected to the other
electrode for measurement. All measurements were
made in duplicate with the Root ZX

II electronic apex
locator (J. Morita, Tokyo, Japan) by a single operator
and a mean was calculated. The electronic measure-
ments were obtained according to the manufacturers
instructions. The le was introduced in the canal until
the red light corresponding to the APEX position on
the devices gauge went on. The silicone stop was
then adjusted again at the limit of the cervical cut, and
the distance between the stop and the tip of the le
was once again measured with an endodontic ruler as
described above. The results obtained were recorded
and the electronic measurement was considered
correct when it coincided with the length obtained
visually with a safety margin of 0.5 mm
14
.
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Cunha et al Influence of gutta-percha solvents on the Root ZXII apex locator 265
ENDO (Lond Engl) 2010;4(4)263266
Results
The Root ZX II detected the apical foramen correctly
within 0.5mm in 100% of the cases in group OPO,
in 90% in group XYL and in 100% in group CHL.
Statistical analysis using the Cochrane C test showed
no signicant difference between the three gutta-
percha solvents regarding their inuence on the ac-
curacy of the Root ZX II to locate the apical foramen
(P = 0.607; Fig 1).
Discussion
The aim of the present study was to evaluate the
inuence of different gutta-percha solvents used in
endodontic retreatment cases on the accuracy of
the Root ZX II apex locator. In cases where the lling
material is difcult to remove, solvents are worthy
allies in promoting its dissolution
14
.
In the present study, the crowns of the teeth were
sectioned to establish a steady reference for meas-
urement taking
15
. The root canals were pre-widened
at their cervical portion with Gates-Glidden burs be-
fore measurement, as suggested in many studies, to
facilitate introduction of the le during the use of the
apex locator, thus facilitating its handling
1,12,16,17
.
Visual measurements were taken previously un-
der 5 magnication with the use of an operative
micro scope to establish the location of the apical fo-
ramen
2
. These measurements were used as controls
(real values) for later comparison with the results
obtained for the Root ZX II. A le that best tted
the anatomic diameter of each root was selected for
the control measurements and for later use with the
apex locator as well. Selection of an instrument ac-
cording to the size of the apical constriction reduces
the risk of establishing a limit beyond the foramen,
which would lead to an improper reading and deter-
mination of the root length
6,18
.
After the control measurements were taken, the
roots were introduced in plastic containers containing
alginate, in such a manner as to leave 1 mm of the
cervical portion of the root exposed. This model was
used because of its proven effectiveness in reproducing
the periodontal ligament, owing to its good electro-
conductivity, as cited by Kaufman
19
, Tinaz et al
20
and
Uzun et al
11
. The roots were then separated in groups
according to the different solutions tested, and a new
measuring procedure was performed with the Root ZX
II. The location of the apical foramen was considered
as that corresponding to the point where the red light
of the APEX mark went on in the devices gauge. A
single experienced operator performed the measure-
ments to reduce the possibility of variation while inter-
preting the readings
10
.
Several studies have demonstrated the effective-
ness of apex locators in determining the working
length
9,10
. However, the authors literature review
failed to nd studies investigating whether gutta-
percha solvents might interfere with the proper
functioning of these devices. The present in vitro
model was chosen for its advantages of simplicity,
easy performance and ability to allow strict control
of the experimental conditions analysed. The nd-
ings of Huang
21
support the use of in vitro models to
Fig 1 Distribution of
the samples accord-
ing to the difference
between the visual and
electronic measurements
of the distance between
the cervical cut limit
and the apical foramen.
(OPO: orange peel oil;
XYL: xylol; CHL: chloro-
form)
Number of
samples
OPO XYL CHL
Sample groups
+1.0 mm
+0.5 mm
+0.0 mm
0.5 mm
1.0 mm
9
8
7
6
5
4
3
2
1
0
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Cunha et al Influence of gutta-percha solvents on the Root ZXII apex locator 266
ENDO (Lond Engl) 2010;4(4):263266
evaluate the effectiveness of electronic apex locators.
Third-generation locators are capable of determin-
ing the point at which the tissues of the periodontal
ligament begins beyond the foramen through electric
measurements
12,19,20,22,23
.
The results of this study indicate that the use of
the electronic apex locator Root ZX II combined with
gutta-percha solvents used in endodontic retreatment
can accurately determine the working length when a
potential error of 0.5 mm from the apical constriction
is accepted as a tolerable range. Several studies
12,16,24

used the margin of error of approximately 0.5 mm
to determine the success of electronic apex locators.
The Root ZX II has been widely studied, and a
high level of success for this device has been dem-
onstrated
13,16,25
. According to the manufacturer, the
device works following the same principles of the
original Root ZX, which was tested in several stud-
ies
21,26
. A study conducted by Lucena-Martin et al
25

showed that the Root ZX was effective in 85% of the
cases. Plotino et al
26
found a 97.37% precision g-
ure. A study conducted by DAssuno et al
16
on the
Root ZX II revealed that it was effective in 97.44% of
the cases investigated
3,27
. Traditionally, apex locators
have an acceptable margin of error in determining the
location of the foramen
10
.
Conclusion
Based on the methodology used and in view of the
results obtained, it was possible to conclude that the
solvents tested in the present study had no inuence
on the ability of the Root ZX II electronic apex locator
to establish the location of the apical foramen.
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